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Pensions and Benefits

STATE HEALTH BENEFITS PROGRAM (SHBP) and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)

HEALTH BENEFITS FOR RETIRED MEMBERS

RETIRED GROUP ELIGIBILITY | PLAN INFORMATION | ENROLLMENT | APPLICATIONS AND FORMS
PRESCRIPTION DRUG PLANS | RETIREE DENTAL PLAN | PLAN RATE CHARTS | CHAPTER 330 ENROLEES

HEALTH BENEFITS HOME | DEPENDENTS | EMPLOYEES | COBRA | EMPLOYERS

 

Retired Members - Plan Year 2017

Information for Plan Year 2017 at a glance:

Medicare Advantage Plans

Summary of Benefits and Coverage — SHBP and SEHPB

Plan Design Comparison Charts for Retired Employees

Retiree Medical Plan Rates

Retirees under Chapter 330

Retiree Dental Rates


RETIRED GROUP ELIGIBILITY

Eligibility for Retired Group SHBP/SEHBP coverage is available to qualified retirees from the State including State colleges and universities, and Participating Local Government Employers, or Local Education Employers, as determined by the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP).

If you have any questions concerning eligibility in the SHBP/SEHBP, contact the Division of Pensions and Benefits.


PLAN INFORMATION AND PROGRAM DESCRIPTIONS

HANDBOOKS AND PUBLICATIONS

PROVIDER INFORMATION — Find a participating doctor or hospital

PRIVACY PRACTICES

OTHER RESOURCES


ENROLLMENT

You are not covered as a retiree until you qualify for and enroll in the Retired Group of the SHBP or SEHBP.

If eligible, you must enroll within 60 days of being offered enrollment — normally as of the date of retirement, or if waived for other coverage upon loss of that other coverage.  See the SHBP/SEHBP Summary Program Description Adobe PDF (597K) for eligibility criteria.

APPLICATIONS AND FORMS

Retiree Enrollment Applications

State and Local Government Retiree Applications

Local Education Retiree Applications


Medicare Enrollment is Required if eligibleMedicare Requirements and Notice Adobe PDF (17K)Medicare & You Adobe PDF (3MB)

Cancel/Decline/Waive Retired Coverage Form - For retirees cancelling, declining, or waiving medical and/or dental coverage

SHBP/SEHBP Cancel/Decline/Waive Retired Coverage Adobe PDF (25K)

Spouse, Civil Union Partner, or Domestic Partner

Children until Age 26

Over Age Children until Age 31 (and Rates)

Over Age Children with Disabilities

Documentation requirements when enrolling dependents for coverage Adobe PDF (33K)

If an eligible dependent is not enrolled within 60 days of the time they first become eligible for coverage, a Retired Group member may enroll them on a timely basis — normally 60 days after receipt by the Division of Pensions and Benefits of of a properly completed Enrollment Application and supporting documentation.


RETIREE PRESCRIPTION DRUG COVERAGE
Retiree Prescription Drug Coverage is included with retired group Medical Plan enrollment

(Medicare Eligible Retirees please also see the Express Scripts Medicare Prescription Drug Plan information below)

Express Scripts is the pharmacy benefits administrator for all Retired Group members of the State Health Benefits Program and School Employees’ Health Benefits Program.

Prescription Drug Plans Member Handbook Adobe PDF (391K)

Express Scripts SHBP/SEHBP Web SiteRegistration Required

Express Scripts Prescription Plan Mobile Phone App — Registration Required


Medicare-Eligible Retirees see below

Express Scripts Mail-Order Form Adobe PDF (95K)

 

Retiree Prescription Drug Copayment and Out-of-Pocket Costs

PRESCRIPTION DRUG BENEFITS FOR ALL PLANS

Retired State Employees Adobe PDF (151K) 2017

Retired Local Government Employees Adobe PDF (151K) 2017

Retired Local Education Employees Adobe PDF (116K) 2017

 

Retired State Employees Adobe PDF (151K) 2016

Retired Local Government Employees Adobe PDF (151K) 2016

Retired Local Education Employees Adobe PDF (116K) 2016

 

Medicare Part D Prescription Drug Coverage

SHBP/SEHBP Medicare Part D Prescription Drug Coveragefor Medicare-Eligible Retirees

Questions and Answers about the Express Scripts Medicare Prescription Drug Plan

Medicare & You — from the Social Security Administration - Adobe PDF (3MB)

Medicare Premiums: Rules for Higher-Income Beneficiaries — from the Social Security Administration - Adobe PDF (400K)

Medical Plan Rates for retirees enrolled in Private Medicare Part D Plans are available by request to the Division's Office of Client Services


RETIREE DENTAL PLANS

Retiree Dental Plans — General Information

Retiree Dental Plans Member HandbookAdobe PDF (207K)

Retirees Dental Plan Rates Plan Year 2017 Adobe PDF (18K)

Retirees Dental Plan Rates Plan Year 2016 Adobe PDF (18K)

See Retired Coverage Enrollment Application or Retired Change of Status Application to apply for dental coverage.

 


RETIRED GROUP MEDICAL PLAN RATES
The cost of Retiree Prescription Drug Coverage is included with the Medical Plan Rates

RATES FOR RETIREES WHO PAY THE FULL COST OF THEIR COVERAGE

Plan Year 2017

If you worked for the State, click here Adobe PDF (9K) 2017

If you worked for a Local Government employer (county, municipal, etc.), click here Adobe PDF (12K) 2017

If you worked for a Local Education employer, click here Adobe PDF (9K) 2017

If you or a dependent are enrolled in a private Medicare Part D plan , click here

Premium Sharing —If you worked for the State, attained 25 years prior to July 1, 2007 (or retired on a disability retirement on or before August 1, 2007) and share the cost of Aetna Freedom10 or NJ DIRECT10 coverage with the State. For 2017 rates: click here Adobe PDF (28K)

Note: State Premium Sharing arrangements are based on these labor bargaining groups


Plan Year 2016

If you worked for the State, click here Adobe PDF (9K) 2016

If you worked for a Local Government employer (county, municipal, etc.), click here Adobe PDF (12K) 2016

If you worked for a Local Education employer, click here Adobe PDF (9K) 2016

If you or a dependent are enrolled in a private Medicare Part D plan , click here

Premium Sharing —If you worked for the State, attained 25 years prior to July 1, 2007 (or retired on a disability retirement on or before August 1, 2007) and share the cost of Aetna Freedom10 or NJ DIRECT10 coverage with the State. For 2016 rates: click here Adobe PDF (28K)

Note: State Premium Sharing arrangements are based on these labor bargaining groups

If you or a dependent are enrolled in a private Medicare Part D plan, click here.

 

CHAPTER 330 RATES

See below for Chapter 330 information and rates

 

Health Benefit Personal Billing Most retirees who pay for health benefits coverage have the premium deducted from the monthly retirement allowance. If there is no monthly retirement allowance, or it is insufficient to cover the premium, members are billed monthly.

Billing "lockbox" payment address information for retirees with personal billing.

 

OVER AGE CHILDREN

Rates for Over Age Children until Age 31 - under Chapter 375, P.L. 2005

COBRA RATES

Rates for COBRA Enrollees

 


INFORMATION and RATES FOR CHAPTER 330 ENROLEES

ABOUT CHAPTER 330, P.L. 1997 — for Retired Law Enforcement and Firefighters

Fact Sheet #47, Health Benefits Coverage Under Chapter 330 Adobe PDF (30K)

 

CHAPTER 330 RATES

If you are a former law enforcement officer/firefighter covered under Chapter 330:

Click here Adobe PDF (18K) for 2017 rates;

Click here Adobe PDF (18K) for 2016 rates.

 


HEALTH BENEFITS HOME | DEPENDENTS | EMPLOYEES | COBRA | EMPLOYERS

 
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